Adherence to Swallowing Rehabilitation Exercises in Head and Neck Cancer

接受大野放射治疗的头颈部癌症患者发生癌症的风险很高。 永久性吞咽障碍。为了防止这种情况，患者可以进行运动锻炼， 加强舌头，增加口咽结构的活动范围。然而， 吞咽困难患者对吞咽练习的坚持程度较低；我们的初步数据表明 只有9.5%的参与者坚持在放射治疗期间进行吞咽练习(n=97)。我们的 干预试点干预，准备(n=16)，表明该方法是高效可行的。 确定遵守吞咽练习的关键调解人和主持人将是有价值的 头颈部癌症患者。主要目的1)比较自我评价的有效性 加强日常护理控制组的监管干预，以提高对 在接受放射治疗的头颈癌患者样本中进行处方吞咽练习。Aim1a) 评估拟议干预措施对坚持自我报告吞咽行为的调节作用 在6周和12个月的随访中进行锻炼。接受测试的调解人将被视为 疾病、应对程序和应对程序的评估。Aim1b)以确定是否 抑郁、疼痛、疲劳和社会支持缓和了干预对依从性的影响 6周随访或12个月随访，或两者兼有。目标2a)测试准备工作的影响 改良金标准X线片法评价解剖吞咽功能的干预 与OPSE一起计分的燕子(MBS)。目标2b)测试 对MDADI和美国疾病控制与预防中心评估的自我报告吞咽功能进行干预 PSS-HN.研究设计：288名患者来自M.D.安德森和林登·贝恩斯·约翰逊 主要为少数族裔、低收入患者提供服务的社区医院将随机分为 两组中的一组：1)加强日常护理，外加一本宣传手册，介绍 吞咽练习，和2)准备，基于自我调节理论的干预 针对粘膜炎、口干症、疲劳、恶心提供目标和激励的应对策略 还有吞咽困难。评估时间点在研究结束后6周的基线进入阶段 放射治疗和放射治疗后12个月。衡量干预措施的影响 吞咽解剖功能，100名参与者的子样本将通过修改后的 在基线和12个月随访时吞钡。摘要：生成的纵向数据 将提供有关坚持吞咽练习的重要信息及其与 理论框架内的解剖吞咽功能。

Head and neck cancer patients who are treated with large-field radiation are at high risk to develop permanent swallowing disorders. To prevent this, patients can perform motor exercises that strengthen the tongue and increase range of motion in oropharyngeal structures. However, adherence to swallowing exercises is low in dysphagic patients; our preliminary data indicated that just 9.5% of the participants were adherent to swallowing exercises during radiation (n=97). Our intervention pilot intervention, PREPARE (n=16) indicates that it is highly effective and feasible. Identifying key mediators and moderators in adherence to swallowing exercises would be valuable to head and neck cancer patients. Primary Aims Aim1) To compare the efficacy of a Self- Regulation intervention with an Enhanced Usual Care control group in increasing adherence to prescribed swallowing exercises in a sample of irradiated head and neck cancer patients. Aim1a) To evaluate the mediators of the proposed intervention on adherence to self-reported swallowing exercises at 6 week and twelve month follow-up. The mediators to be tested will be perception of illness, coping procedures and appraisal of coping procedures. Aim1b) To determine whether depression, pain, fatigue and social support moderate the impact of the intervention on adherence at 6 week follow-up or 12 month follow-up or both. Aim 2a) To test the impact of the PREPARE intervention on anatomic swallowing function as assessed by gold-standard radiographic Modified Barium Swallow (MBS), which is scored with the OPSE. Aim 2b) To test the impact of the PREPARE intervention on self-reported swallowing function as assessed by the MDADI and the PSS-HN. Study design: 288 patients recruited from M. D. Anderson and Lyndon Baines Johnson Community hospital, which serves primarily minority, low-income patients, will be randomized into one of two groups: 1) Enhanced Usual care plus an informational brochure about the importance of swallowing exercises, and 2) PREPARE, an intervention based on the Theory of Self-Regulation delivering objective and motivational coping strategies for mucositis, xerostomia, fatigue, nausea and dysphagia. Assessment timepoints are at baseline entry into the study, 6 weeks after the end of radiation therapy, and 12 months post-radiation. To measure the impact of the intervention on swallowing anatomic function, a subsample of 100 participants will be measured by modified barium swallow at baseline and at 12 month follow-up. Summary: The resulting longitudinal data will yield important information about adherence to swallowing exercises and its relationship to anatomic swallowing function within a theoretical framework.